title: Nosocomial infection after septic shock among intensive care unit patients.
abstract: OBJECTIVE
  To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two intensive care units (ICUs) of a French university hospital.
  
  
  METHODS
  The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.
  
  
  RESULTS
  Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).
  
  
  CONCLUSIONS
  The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.
authors.affiliation: Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, and the Centre d'Investigation Clinique de Lyon, CIC201, Inserm, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Landelle
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.forename: Adrien
authors.initials: A
authors.lastname: Français
authors.forename: Eve
authors.initials: E
authors.lastname: Tognet
authors.forename: Hélène
authors.initials: H
authors.lastname: Thizy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Voirin
authors.forename: Jean François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Guillaume
authors.initials: G
authors.lastname: Monneret
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology*